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Claims Processing Specialist - Post Bill

Location : Mesa AZ
Job Type : Temp/Contract to Direct
Compensation : open - $15.00 to $16.0
Hours : Full Time

Job Description :

Position Summary:


The primary job responsibility of the Claims Processing Specialist is to follow up on Medicaid/AHCCCS, Medicare, Commercial Insurance and Contracted claims directly with the payers.




Essential Functions:





  • The Claims Processing Specialist may be assigned one or more duties. These duties may include, but are not limited to, the following:



  • Verify submitted claims forms is complete and accurate, updating system information as needed.



  • Superior data entry proficiency



  • Process claims according to guidelines while identifying claims requiring exception handling.



  • Prioritize and coordinate influx of daily workload for claims processing, returned mail, and out-going correspondence and emails to assure required turnaround time us met.



  • Assess accuracy of system adjudication and alert management of potential problems affecting the integrity of claim processing.



  • Effectively work through denial/appeal process and meeting filing requirements.



  • Work with department manager to determine special projects on an as needed basis.



  • Participate in documentation feedback information for the operations.



  • Obtain continuous knowledge of CMS regulations.



  • Make decisions and take appropriate actions based on sound reasoning and judgment.



  • Contribute ideas; strive to enhance team effectiveness and support decisions made by the team.



  • Plan and perform work systematically and efficiently.



  • Carry out instructions, maintain a positive attitude, and support company policies/procedures.



  • Punctuality and availability for workload.



  • Comply with HIPAA guidelines



  • Attend and maintain all required Falck USA training



  • Maintain knowledge of functional area and company policies and procedures


 


Additional Duties:


The Claims Processing Specialist may be assigned one or more additional duties. These duties may include, but are not limited to, the following:



  • Assist with training new employees



  • Providing feedback to management concerning possible problems or areas of improvement



  • Making recommendations to implement improved processes.



  • Performing other duties as assigned by management.




 



Required Qualifications :
Medical claims or billing follow up - AR cleanup is helpful.

Understanding of medical billing, claims and collections.

Strong communication skills.

Attention to detail.

 
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